Wu Gao-Feng, He Chen-Hao, Xi Wen-Tao, Zhai Wen-Bo, Li Zong-Ze, Zhu Ye-Cheng, Tang Xiu-Bo, Yan Xia-Lin, Lynch Gordon S, Shen Xian, Huang Dong-Dong
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325000, China.
First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China.
BMC Cancer. 2025 Apr 14;25(1):679. doi: 10.1186/s12885-025-13967-7.
Global Leadership Initiative in Sarcopenia (GLIS) has recently established a conceptional definition of sarcopenia, which incorporated muscle strength, mass, and muscle-specific strength as three components of sarcopenia. The present study aimed to investigate the value of sarcopenia defined by the GLIS consensus in predicting the postoperative outcomes.
Clinical data of 1654 patients who underwent radical gastrectomy for gastric cancer were prospectively collected. Muscle strength was measured by the grip strength test. Muscle mass was measured by calculating skeletal muscle index (SMI) using abdominal computed tomography images. Muscle-specific strength was determined by the ratio of grip strength to SMI. Sarcopenia was diagnosed by having low muscle-specific strength (criteria 1), or low muscle strength plus low muscle mass (criteria 2), or low muscle strength plus either low muscle mass or low muscle-specific strength (criteria 3).
The incidence of sarcopenia identified by criteria 1, 2, and 3 were 24.2%, 17.0%, and 32.5%, respectively. All three criteria showed significant association with postoperative total complications, overall survival (OS), and disease-free survival (DFS). However, criteria 1 showed no significant association with severe complications. Criteria 2 did not remain significant in predicting DFS in the multivariate analyses. Criteria 3 showed the largest Youden index and area under receiver operating characteristic curve (AUC) in predicting total complications, 3-year and 5-year mortality, and low physical performance.
Sarcopenia defined by low muscle strength plus either low muscle mass or low muscle-specific strength showed optimal predictive value for postoperative outcomes in patients with gastric cancer.
全球肌肉减少症领导力倡议组织（GLIS）最近制定了肌肉减少症的概念性定义，该定义将肌肉力量、肌肉量和肌肉特异性力量作为肌肉减少症的三个组成部分。本研究旨在探讨GLIS共识定义的肌肉减少症在预测术后结局方面的价值。
前瞻性收集1654例行胃癌根治术患者的临床资料。通过握力测试测量肌肉力量。利用腹部计算机断层扫描图像计算骨骼肌指数（SMI）来测量肌肉量。肌肉特异性力量通过握力与SMI的比值来确定。肌肉减少症的诊断标准为：肌肉特异性力量低（标准1），或肌肉力量低加肌肉量低（标准2），或肌肉力量低加肌肉量低或肌肉特异性力量低（标准3）。
根据标准1、2和3确定的肌肉减少症发生率分别为24.2%、17.0%和32.5%。所有三个标准均与术后总并发症、总生存期（OS）和无病生存期（DFS）显著相关。然而，标准1与严重并发症无显著关联。在多变量分析中，标准2在预测DFS方面不再显著。标准3在预测总并发症、3年和5年死亡率以及身体功能低下方面显示出最大的约登指数和受试者工作特征曲线下面积（AUC）。
肌肉力量低加肌肉量低或肌肉特异性力量低所定义的肌肉减少症对胃癌患者术后结局具有最佳预测价值。
